Standards for Surgeons

With his creation of the American College of Surgeons 100 years ago, Franklin Martin introduced a vital aspect to surgery: regulation.

The turn of the twentieth century held mixed blessings for surgery patients. On the plus side, surgical techniques were improving, surgery was being used to treat a wider range of conditions, and anesthetics were more prevalent. But general practitioners did most operations, and there was no guarantee of their competence. Surgery had become a free-for-all, attracting medical school graduates seeking not just prestige but financial rewards. Fee splitting, in which surgeons gave part of their payments to referring doctors, gave financial incentives to both and resulted in unnecessary surgeries.

Top surgeons demanded that their profession be kept honest through standardized training and regulation. The catalyst would turn out to be an enterprising young surgeon, Franklin Martin, who founded the American College of Surgeons 100 years ago.

After graduating from medical school in 1880, he interned at Chicago’s Mercy Hospital and soon distinguished himself as a superior gynecological surgeon. In 1889, Martin co-founded the Chicago Post-Graduate Medical School. In 1905 he launched a medical journal, Surgery, Gynecology and Obstetrics, which, unlike other journals of the time, was more practical than theoretical. (It still exists as the Journal of the American College of Surgeons.) And in 1910, Martin used the journal to gather surgeons for training at the first Clinical Congress of Surgeons
of North America. Some 1,300 surgeons showed up, and the congress became an annual event. At the 1912 meeting, Martin proposed creating a permanent organization. In 1913, thanks to the efforts of Martin, Ernest Codman of Massachusetts General Hospital and other surgical leaders, the American College of Surgeons came to life.

Today, more than a third of the country’s approximately 183,000 surgeons bear the title Fellow of the American College of Surgeons. And the country’s leading hospitals employ the college’s training courses, says David Hoyt, ACS’s executive director, who notes that “these programs measure outcomes, prevent complications, reduce costs and save lives”—just as Martin intended.

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